The lethality of penetrating cardiac wounds

The objective was to review our experience in the presentation and management of patients with penetrating cardiac injuries, using physiologic and anatomic indices. The setting was a 400-bed Level I urban trauma center. A 6-year retrospective case study was undertaken. The revised trauma score, physiologic index (PI), penetrating cardiac trauma index, penetrating thoracic trauma index, penetrating trauma index, and cardiac injury organ score were determined. Fifty patients responded to emergency room resuscitation and reached the operating room. Overall survival was 66 per cent. The admission PI correlated well with outcome. Patients presenting in shock (PI, 10; revised trauma score, 7-10) appeared to have higher survival rates when compared to those patients with a normotensive presentation. Twenty-three per cent of patients admitted with a PI < or = 10 died despite reaching the operating room within a mean of 45 minutes. Although the majority of patients who reach the operating room survive, a significant number of (initially normotensive) patients die soon after cardiorrhaphy.